Pirfenidone treatment decreases necroinflammation grade, fibrosis stage and steatosis. Representative photomicrographs of liver biopsy were stained with H&E showing necroinflammation (A) and trichromic Masson staining for fibrosis (B) before and after of treatment. In (A) arrows indicate that inflammatory cell infiltrate is reduced post-treatment. In (B) collagen fibers clearly are reduced after PDF treatment. (C) Graph indicates mean ± SD initial and final values for necroinflammation grade that reduced an average of 2.6 points in 81.8% of patients (p < 0.01). Mean ± SD initial and post-treatment fibrosis stage is represented in (D); stage decreased 2 points as average in 67% of patients (p < 0.05) by the end of treatment. (E) Representative sections of liver tissue were stained with H&E to determine steatosis area. Representative microphotographs (patient 05) showed before treatment macro-steatosis and micro-steatosis, and an obvious decline in steatosis is evident by the end of treatment. (F) Individual data for percentage of steatosis indicates decrease in liver fat-area in 8/13 patients, while in 5/13 patients steatosis remains.